DIMH 2018 keynotes

REDUCING SUICIDES Alongside this, Professor Kendall explained that NHS England would be ‘doing work around reducing suicide’, in line with Jeremy Hunt’s announcement, late in January, of a ‘zero suicide aim’ for inpatient units. While suicides within mental health had fallen year-on-year for 15 years, there were still currently, he said, around 1,200 within the sphere every year. The speaker said: “We want to bring that down as much as possible. We’ve seen the biggest decline in suicides in inpatient mental health units, and we have to go on pushing them down to reduce numbers as much as possible.” Having by now covered much of the subject

Professor Kendall, pictured with another of the conference’s speakers, Mark Brown.

Trusts sign off that they understand and believe their figures.”

GOALS FOR THE NEXT YEAR Looking at NHS England’s goals for the next financial year, and Professor Kendall said the target figure of 49,000 children and young people getting access to high quality mental healthcare should be reached. “However,” he noted, “that is only increasing the number of children and young people we could potentially see from 25 up to 33 per cent, which is why there is a Green Paper coming, which has already been through consultation, and will be launched in June. There is money attached to it, and a 10-year programme to effectively double the number of people working with children with mental health problems. It will provide an inreach mental health service into schools, and ensure that every school has a mental health lead. This won’t be mandatory, but we will train such people, and it will be supported by the mental health support schemes working in schools.” The Professor noted that ‘in the first couple of years we will be piloting a four-week waiting time for the whole of CAMHS’. He added: “It is thus more than just the Five Year Forward View. We will start preparations this year. We are also expecting 9,000 more women to access specialist perinatal mental healthcare.”

NHSI AND NHSE WORKING IN TANDEM Professor Kendall told the audience here that he had recently ‘joined’ NHS Improvement, as well as continuing to serve NHS England. He said: “I have been doing NHS Improvement work now for about 14 months. There is a lot going on with NHSI in terms of supporting the development of mental health providers.” His next topic was a number of key NHSI priorities for 2018/2019, in line with this. He explained: “To look at one key initiative, on being appointed Health Secretary, Jeremy Hunt was plunged into the midst of the furore over the NHS in Mid-Staffordshire, and was not only shocked to discover what had happened, but also to learn – from the resulting report – that some of the major issues could happen undetected in other healthcare locations. He also discovered that, worldwide, every health system harms some 10 per cent of the people coming to it for care.” Jeremy Hunt had consequently put ‘a very major focus’ on health and safety improvement across the whole

of the English healthcare system. As part of this, 18 months ago he had asked Professor Kendall and ‘a number of counterparts’ how they might do this in mental health.

HEALTH SECRETARY ‘TOURING TRUSTS’ The Health Secretary was now looking to visit every English mental health Trust to talk to key people on the subject, often accompanied by Professor Kendall, who added that, having worked with the CQC, NHSI had ‘already worked out’ which Trusts were ‘struggling with safety’; these were generally ‘those struggling with leadership’. “He added: “We have now contacted all the Trusts facing an uphill task with health and safety, and are looking at what help we can give them. We are also getting NHSI’s ongoing safety improvement work linked up with the CQC cycle, so that in 18 months we will have created a virtuous cycle.”

SITTING DOWN TO SUGGEST IMPROVEMENTS The Professor explained that – under the ‘system’ configured – after the CQC had come in and assessed a provider’s core services, he and his NHS England colleagues would sit down with the CQC, the Trust, and NHSI, to develop a plan. He added: “Some of what we do will be brokering arrangements with other Trusts; each has something to offer. For example, the only mental health Trust currently in ‘special measures’, Norfolk and Suffolk NHS Foundation Trust, has some outstanding services. The fact that they are struggling in some areas doesn’t mean they are struggling in all.” Professor Kendall said this was something he and his colleagues found in most Trusts they visited. He expanded: “Every time any of the team goes with Jeremy Hunt to see a Trust and its Board, we go through all of both their ‘difficult’ and their ‘top’ services; so far we’ve not found a single Trust show anything other than a complete willingness to share its good practice with other Trusts struggling in that area. “We are thus planning to form the National Patient Safety Network,” the speaker explained. “Its remit will not only be patient safety, but there will be key patient safety areas that we focus on.” One of the first areas to be targeted will be ‘Restrictive Interventions’. He elaborated: “There will be quite a big national thrust to help Trusts to bring down their use of restrictive interventions.”

matter around work being undertaken by NHSI and NHSE, Professor Kendall said that, before closing, he wanted to focus on ‘a really common factor which comes up time and time again’ with the English NHS mental health Trusts. He explained: “That factor is the poor quality of the inpatient estate. In some areas we think the quality, or lack of it, in the estate, is limiting patient safety. We are, however, finding ways via which we can help all Trusts with their estate. That is a big ask, and I cannot make any promises of any kind, except that we are looking at this, and will work hard to help wherever, and whenever, we can.”

OPPORTUNITIES FOR GOOD DESIGN “The second thing I wanted to mention before closing,” the NHS England speaker added, “is that there are a number of opportunities for design – for instance in Mother and Baby units. Notwithstanding what I said before, what makes us different to a prison is that it’s therapeutic. We’re not just about denying people their liberty. We should do that only where it is absolutely necessary to protect the individual or society. What we should be doing instead is ensuring that NHS mental healthcare facilities provide therapeutic space – not any old space where you ‘bung’ somebody because they are a danger. The space needs to be a pleasurable place to be, and I’m not sure we always get that right. We usually get it right around security and health and safety, but I am aware that these often clash with ‘being therapeutic and being pleasurable’.” Looking at some of the other areas where good design of the mental health space was fundamental, Professor Kendall identified ‘A&E’. He said: “These are areas where large numbers of people go through – 200,000 people go into A&E annually after self-harming, plus many more individuals go into A&E with mental health problems. Equally, if you expand IAPT, is anybody thinking about how we modify primary care and community mental health centres? So, I wouldn’t want everyone to go away and think that this agenda is all about inpatient services, which, after all, cater for just 2% of all the people with mental health problems that we deal with. It’s much more than that; it’s across the whole health service. So, there’s the challenge. Thank you very much.” This brought to a close an interesting and forthright presentation from the National Clinical director for Mental Health at NHS England, who then took a number of questions from the floor.



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